GPs in some of the poorest areas of the country are failing to identify patients with coronary heart disease and treat them effectively, HSJ’s analysis suggests.
HSJ compared the number of patients that GPs in each primary care trust identified as having coronary heart disease in 2006-07 with the number of premature deaths from the condition in 2006. In inner city London, the rate of premature death to heart disease detection was as high as one to every 43 identified patients. In leafier parts of southern England the rate was as low as one death to every 124 identified patients.
GPs report the numbers of patients they have identified as having heart disease as part of their quality and outcomes framework bonus system. They are then paid for reducing cardiovascular risk factors in the patients identified.
Jacky Chambers, public health director at Heart of Birmingham teaching PCT, which has the second highest rate of heart disease deaths to GP detection, told HSJ: “We have a lot of single-handed practices which have big list sizes and because of the deprivation, there are a lot of demands on those practices.
“The combination of patients not necessarily recognising that they have the symptoms of heart disease and short consultation periods means we don’t have as many people on the disease registers as you might expect from the death profile.”
The average rate of premature death to detection was one premature death for every 71 patients on GP coronary heart disease registers. At one death for every 43 detections, Islington PCT had the highest death rate - indicating that GPs were either not reaching all the needy patients or that care was ineffective. The lowest death-to-detection rate was at Bournemouth and Poole teaching PCT with 124 detections to each death.
Islington PCT public health director Sarah Price said the problem was detection. “We do pretty well in managing people once we know they have heart disease, but we don’t always find the people we need to. We could do better at that.”
National primary care director David Colin-Thome told HSJ: “This is something the government is trying to address through its under-doctored area strategy. Personally I would also like them to put more incentives into QOF to reflect true prevalence of diseases.”
He said the current GP contract did not properly incentivise GPs in poorer areas to actively seek out hard-to-reach patients.
The possibility of extra payments to deprived areas had been deliberately left to one side when the contract was first negotiated as it would have meant middle class areas losing out, said Dr Colin-Thome.
It was a proposal he would like to see returned to, although it was unlikely to feature in the current set of negotiations around GP pay and extended opening hours.